New Member Application

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If you are interested in joining the Rock River Officials Association, please attend a meeting and announce your intentions.  A listing of meeting dates and times can be found on the website.  Below is a sample of the application.  We look forward to you joining our association.

 

 

 
                 
        Rock River Officials Association  
        Registration and Dues Application Form  
        2017-18 Season        
                   
                   
       
                   
  NAME:                
                   
  ADDRESS:                
                   
  CITY:         ZIP:      
                   
  HOME PHONE:         AGE:      
                   
  CELL PHONE:         D.O.B.      
                   
  EMAIL ADDRESS:                
  * Must have email                
                   
I am currently a licensed official in the state of Illinois… YES: NO:    
                   
If YES, my I.H.S.A. identification number is...  #        
                   
If NO, I plan to get/have my license by this date…          
                   
  SPORT:     LEVEL OF CERTIFICATION:     Years officiated    
      Registered Recognized Certified   in this sport    
  Baseball                
  Basketball              
  Football                
  Soccer                
  Softball                
  Track/Field              
  Volleyball              
  Wrestling              
                   
                   
Membership - $40.00 (due on/before June 30th) Amount: $      
Student Membership - $15.00       Amount $      
Late Fee - $10.00 (after June 30th)    Amount: $      
                   
          Total: $      
Make checks payable to R.R.O.A.            
                   
Please mail this completed form with payment to:          
John Kereven, Treasurer              
Rock River Officials Association            
313 Ada Street                
Rock Falls, Illinois  61071              
        All information listed is accurate as of this date…  
                   
        Signature:          
                   
        Date: